NRS 439B.265 Collection
of deductible or copayment from indigent patient covered by Medicare
prohibited. [Effective upon confirmation by the Federal Government that the
deductibles and copayments which a hospital is prohibited from collecting from
a patient pursuant to this section are deemed uncollectible for the purposes of
federal law.]

NRS 439B.320 Hospital
required to provide care for proportionate share of indigent patients; duties
of Department and board of county commissioners; reimbursement for care.

NRS 439B.330 Eligibility
of indigent for assistance; payment of hospital for serving disproportionately
large share of patients; discharge forms; appeal from determination of county
regarding indigent status.

NRS 439B.010Definitions.As
used in this chapter, unless the context otherwise requires, the words and
terms defined in NRS 439B.030 to 439B.150, inclusive, have the meanings ascribed to
them in those sections.

NRS 439B.030“Billed charge” defined.“Billed
charge” means the total amount charged by a hospital for medical care provided,
regardless of the anticipated amount of net revenue to be received or the
anticipated source of payment.

NRS 439B.110“Hospital” defined.“Hospital”
means any facility licensed as a medical, surgical or obstetrical hospital, or
as any combination of medical, surgical or obstetrical hospital, by the
Division of Public and Behavioral Health of the Department.

NRS 439B.115“Major hospital” defined.“Major
hospital” means a hospital in this State which has 200 or more licensed or
approved beds, or any hospital in a group of affiliated hospitals in a county
which have a combined total of 200 or more licensed or approved beds, that is
not operated by a federal, state or local governmental agency.

NRS 439B.120“Medicaid” defined.“Medicaid”
means the program established pursuant to Title XIX of the Social Security Act,
42 U.S.C. §§ 1396 et seq., to provide assistance for part or all of the cost of
medical care rendered on behalf of indigent persons.

NRS 439B.130“Medicare” defined.“Medicare”
means the program of health insurance for aged persons and persons with
disabilities established pursuant to Title XVIII of the Social Security Act, 42
U.S.C. §§ 1395 et seq.

1. There is hereby established a
Legislative Committee on Health Care consisting of three members of the Senate
and three members of the Assembly, appointed by the Legislative Commission. The
members must be appointed with appropriate regard for their experience with and
knowledge of matters relating to health care.

2. No member of the Committee may:

(a) Have a financial interest in a health
facility in this State;

(b) Be a member of a board of directors or
trustees of a health facility in this State;

(c) Hold a position with a health facility in
this State in which the Legislator exercises control over any policies
established for the health facility; or

(d) Receive a salary or other compensation from a
health facility in this State.

3. The provisions of subsection 2 do not:

(a) Prohibit a member of the Committee from
selling goods which are not unique to the provision of health care to a health
facility if the member primarily sells such goods to persons who are not
involved in the provision of health care.

(b) Prohibit a member of the Legislature from
serving as a member of the Committee if:

(1) The financial interest, membership on
the board of directors or trustees, position held with the health facility or
salary or other compensation received would not materially affect the
independence of judgment of a reasonable person; and

(2) Serving on the Committee would not
materially affect any financial interest the member has in a health facility in
a manner greater than that accruing to any other person who has a similar
interest.

4. The Legislative Commission shall review
and approve the budget and work program for the Committee and any changes to
the budget or work program. The Legislative Commission shall select the Chair
and Vice Chair of the Committee from among the members of the Committee. Each
such officer shall hold office for a term of 2 years commencing on July 1 of
each odd-numbered year. The office of the Chair of the Committee must alternate
each biennium between the houses of the Legislature.

5. Any member of the Committee who does
not become a candidate for reelection or who is defeated for reelection
continues to serve after the general election until the next regular or special
session of the Legislature convenes.

6. Vacancies on the Committee must be
filled in the same manner as original appointments.

7. The Committee shall report annually to
the Legislative Commission concerning its activities and any recommendations.

1. Except as otherwise ordered by the
Legislative Commission, the members of the Committee shall meet not earlier
than November 1 of each odd-numbered year and not later than August 31 of the
following even-numbered year at the times and places specified by a call of the
Chair or a majority of the Committee. The Director of the Legislative Counsel
Bureau or a person designated by the Director shall act as the nonvoting
recording Secretary. The Committee shall prescribe regulations for its own
management and government. Four members of the Committee constitute a quorum,
and a quorum may exercise all the powers conferred on the Committee.

2. Except during a regular or special
session of the Legislature, members of the Committee are entitled to receive
the compensation provided for a majority of the members of the Legislature
during the first 60 days of the preceding regular session for each day or
portion of a day during which the member attends a meeting of the Committee or
is otherwise engaged in the business of the Committee plus the per diem
allowance provided for state officers and employees generally and the travel
expenses provided pursuant to NRS
218A.655.

3. The salaries and expenses of the
Committee must be paid from the Legislative Fund.

1. Review and evaluate the quality and
effectiveness of programs for the prevention of illness.

2. Review and compare the costs of medical
care among communities in Nevada with similar communities in other states.

3. Analyze the overall system of medical
care in the State to determine ways to coordinate the providing of services to
all members of society, avoid the duplication of services and achieve the most
efficient use of all available resources.

4. Examine the business of providing
insurance, including the development of cooperation with health maintenance
organizations and organizations which restrict the performance of medical
services to certain physicians and hospitals, and procedures to contain the costs
of these services.

5. Examine hospitals to:

(a) Increase cooperation among hospitals;

(b) Increase the use of regional medical centers;
and

(c) Encourage hospitals to use medical procedures
which do not require the patient to be admitted to the hospital and to use the
resulting extra space in alternative ways.

6. Examine medical malpractice.

7. Examine the system of education to
coordinate:

(a) Programs in health education, including those
for the prevention of illness and those which teach the best use of available
medical services; and

(b) The education of those who provide medical
care.

8. Review competitive mechanisms to aid in
the reduction of the costs of medical care.

9. Examine the problem of providing and
paying for medical care for indigent and medically indigent persons, including
medical care provided by physicians.

10. Examine the effectiveness of any
legislation enacted to accomplish the purpose of restraining the costs of
health care while ensuring the quality of services, and its effect on the subjects
listed in subsections 1 to 9, inclusive.

11. Determine whether regulation by the
State will be necessary in the future by examining hospitals for evidence of:

(a) Degradation or discontinuation of services
previously offered, including without limitation, neonatal care, pulmonary
services and pathology services; or

(b) A change in the policy of the hospital
concerning contracts,

Ê as a result
of any legislation enacted to accomplish the purpose of restraining the costs
of health care while ensuring the quality of services.

12. Study the effect of the acuity of the
care provided by a hospital upon the revenues of the hospital and upon
limitations upon that revenue.

13. Review the actions of the Director in
administering the provisions of this chapter and adopting regulations pursuant
to those provisions. The Director shall report to the Committee concerning any
regulations proposed or adopted pursuant to this chapter.

14. Identify and evaluate, with the
assistance of an advisory group, the alternatives to institutionalization for
providing long-term care, including, without limitation:

(a) An analysis of the costs of the alternatives
to institutionalization and the costs of institutionalization for persons
receiving long-term care in this State;

(b) A determination of the effects of the various
methods of providing long-term care services on the quality of life of persons
receiving those services in this State;

(c) A determination of the personnel required for
each method of providing long-term care services in this State; and

(d) A determination of the methods for funding
the long-term care services provided to all persons who are receiving or who
are eligible to receive those services in this State.

15. Evaluate, with the assistance of an
advisory group, the feasibility of obtaining a waiver from the Federal
Government to integrate and coordinate acute care services provided through
Medicare and long-term care services provided through Medicaid in this State.

16. Evaluate, with the assistance of an
advisory group, the feasibility of obtaining a waiver from the Federal
Government to eliminate the requirement that elderly persons in this State
impoverish themselves as a condition of receiving assistance for long-term
care.

17. Conduct investigations and hold
hearings in connection with its review and analysis and exercise any of the
investigative powers set forth in NRS
218E.105 to 218E.140, inclusive.

18. Apply for any available grants and
accept any gifts, grants or donations to aid the Committee in carrying out its
duties pursuant to this chapter.

19. Direct the Legislative Counsel Bureau
to assist in its research, investigations, review and analysis.

20. Recommend to the Legislature as a
result of its review any appropriate legislation.

21. Prescribe duties and make requests, in
addition to those set forth in NRS 439B.250, of the
Nevada Academy of Health established pursuant to that section.

2. The Committee shall review each
regulation that a licensing board proposes or adopts that relates to standards
for the issuance or renewal of licenses, permits or certificates of
registration issued to a person or facility regulated by the board, giving consideration
to:

(a) Any oral or written comment made or submitted
to it by members of the public or by persons or facilities affected by the
regulation;

(b) The effect of the regulation on the cost of
health care in this State;

(c) The effect of the regulation on the number of
licensed, permitted or registered persons and facilities available to provide
services in this State; and

(d) Any other related factor the Committee deems
appropriate.

3. After reviewing a proposed regulation,
the Committee shall notify the agency of the opinion of the Committee regarding
the advisability of adopting or revising the proposed regulation.

4. The Committee shall recommend to the
Legislature as a result of its review of regulations pursuant to this section
any appropriate legislation.

1. After each regular session of the
Legislature, review any chapter added to this title or title 39 or 54 of NRS
that authorizes or requires the issuance of a license, permit or certificate to
a person who provides any service related to health care to determine if the
person should be included as a person required to make a report pursuant to NRS 432B.220; and

2. Before the beginning of the next
regular session of the Legislature, prepare a report concerning its findings
pursuant to subsection 1 and submit the report to the Director of the
Legislative Counsel Bureau for transmittal to the Legislature. The report must
include, without limitation, any recommended legislation.

NRS 439B.250Establishment; members; qualifications of members; election of
Chair; compensation of members; members holding public office or employed by
governmental entity; vacancies; duties; appointment of advisory committees
authorized; acceptance of gifts and grants.

1. There is hereby established the Nevada
Academy of Health consisting of 13 members as follows:

(a) The Director or a designee of the Director;

(b) One member who represents the Nevada System
of Higher Education appointed by the Board of Regents of the University of
Nevada;

(c) Four members appointed by the Governor;

(d) Two members appointed by the Majority Leader
of the Senate;

(e) Two members appointed by the Speaker of the
Assembly;

(f) One member appointed by the Minority Leader
of the Senate;

(g) One member appointed by the Minority Leader
of the Assembly; and

(h) The authorized representative for the State
of Nevada of a quality improvement organization of the Centers for Medicare and
Medicaid Services of the United States Department of Health and Human Services
which operates in this State or his or her designee.

2. The members appointed to the Academy
pursuant to subsection 1 must not be Legislators and, to the extent
practicable, must:

(a) Represent agencies and organizations that
provide education or training for providers of health care;

(b) Be advocates for the rights of patients;

(c) Be recognized academic scholars; or

(d) Be members of the general public who have
specialized knowledge and experience that are beneficial to the Academy.

3. The Chair of the Academy must be
elected from among the members of the Academy.

4. Each member of the Academy who is not
an officer or employee of the State serves without compensation and is not entitled
to receive a per diem allowance or travel expenses.

5. Each member of the Academy who is an
officer or employee of the State must be relieved from his or her duties
without loss of his or her regular compensation so that the officer or employee
may attend meetings of the Committee or the Academy and is entitled to receive
the per diem allowance and travel expenses provided for state officers and
employees generally, which must be paid by the state agency that employs the
officer or employee.

6. The term of office of a member of the
Academy is 2 years. A vacancy occurring in the membership of the Academy must
be filled in the same manner as the original appointment. A member of the
Academy may be reappointed.

7. The Academy shall:

(a) Perform any duties prescribed by, and comply
with all requests from, the Committee;

(b) Study issues relating to health care in this
State, including, without limitation:

(1) Medical and clinical research;

(2) The education and training of
providers of health care;

(3) The improvement of accountability
within the system of health care in this State;

(4) The improvement of access to and
quality of health care in this State; and

(5) The improvement of the health of the
residents of this State;

(c) Establish standards and goals concerning the
provision of health care which are measurable and regularly evaluated;

(d) Analyze and evaluate data relating to health
care that is created, collected or reviewed by the Committee and the
Department;

(e) Promote cooperation and partnerships between
the public and private sectors, including the development and implementation of
technology used to provide health care and the establishment of business
partnerships that promote economic development in this State;

(f) Provide to the Committee:

(1) Such assistance and technical
expertise on matters relating to health care as the Committee may request; and

(2) Advice and recommendations from
consumers of health care; and

(g) Provide to the Department, at the direction of
the Committee:

(1) Technical expertise in matters
relating to health care; and

(2) Advice and recommendations from
consumers of health care.

8. The Academy may appoint advisory
committees if necessary or appropriate to assist the Academy in carrying out
the provisions of this section.

9. The Academy may accept gifts, grants
and donations of money from any source to carry out the provisions of this
section.

1. A major hospital shall reduce or
discount the total billed charge by at least 30 percent for hospital services
provided to an inpatient who:

(a) Has no policy of health insurance or other
contractual agreement with a third party that provides health coverage for the
charge;

(b) Is not eligible for coverage by a state or
federal program of public assistance that would provide for the payment of the
charge; and

(c) Makes reasonable arrangements within 30 days
after the date that notice was sent pursuant to subsection 2 to pay the
hospital bill.

2. A major hospital shall include on or
with the first statement of the hospital bill provided to the patient after his
or her discharge a notice of the reduction or discount available pursuant to
this section, including, without limitation, notice of the criteria a patient
must satisfy to qualify for a reduction or discount.

3. A major hospital or patient who
disputes the reasonableness of arrangements made pursuant to paragraph (c) of
subsection 1 may submit the dispute to the Bureau for Hospital Patients for
resolution as provided in NRS 223.575.

4. A major hospital shall reduce or
discount the total billed charge of its outpatient pharmacy by at least 30
percent to a patient who is eligible for Medicare.

(b) A health benefit plan, as that term is
defined in NRS 689A.540, for
employees which provides coverage for services and care at a hospital;

(c) A participating public agency, as that term
is defined in NRS 287.04052, and any
other local governmental agency of the State of Nevada which provides a system
of health insurance for the benefit of its officers and employees, and the
dependents of officers and employees, pursuant to chapter
287 of NRS; or

(d) Any other insurer or organization providing
health coverage or benefits in accordance with state or federal law.

Ê The term
does not include an insurer that provides coverage under a policy of casualty
or property insurance.

NRS 439B.265Collection of deductible or copayment from indigent patient
covered by Medicare prohibited. [Effective upon confirmation by the Federal
Government that the deductibles and copayments which a hospital is prohibited
from collecting from a patient pursuant to this section are deemed
uncollectible for the purposes of federal law.]A
major hospital shall not collect or seek to collect the deductible or copayment
from a patient who is covered by Medicare and who demonstrates that he or she
is medically indigent, as that term is defined for the purposes of Medicaid
coverage for persons in long-term care. The hospital may seek and collect
payment for the deductible or copayment from any source other than the patient,
including from the supplemental insurance of the patient.

(Added to NRS by 1991, 2332,
effective upon confirmation by the Federal Government that the deductibles and
copayments which a hospital is prohibited from collecting from a patient
pursuant to this section are deemed uncollectible for the purposes of federal
law)

1. The major hospitals shall jointly
establish a foundation for hospital nursing practice to promote and encourage
the practice of nursing in hospitals.

2. The foundation must be created as a
nonprofit entity in compliance with 26 U.S.C. § 501. The governing body of the
foundation must consist of one representative of each of the member hospitals
and one representative appointed by the Governor. The governing body must have
authority to establish rules for the administration of the foundation, to
establish programs in pursuit of its purpose, and to allocate money for its
programs.

3. If the foundation is not formed, or
ceases to exist, the Director shall establish a nonprofit entity to carry out
the foundation’s purpose.

NRS 439B.275Program for provision of technical assistance to rural
hospitals.The major hospitals
shall, in cooperation with the Office of the Governor, the University of Nevada
School of Medicine and organizations representing rural hospitals, develop a
program for the provision of technical assistance to rural hospitals in Nevada.
The resources required to carry out this program must be determined and
provided by the major hospitals.

NRS 439B.280Educational program to promote wellness, physical fitness and
prevention of disease and accidents.The
major hospitals shall sponsor an educational program to promote wellness,
physical fitness and the prevention of disease and accidents. The program must
be:

(a) The practice of refusing to treat an indigent
patient if another hospital can provide the treatment endangers the health and
well-being of such patients.

(b) Counties in which more than one hospital is
located may lack available resources to compensate for all indigent care
provided at their hospitals. Refusal by a hospital to treat indigent patients
in such counties results in a burden upon hospitals which treat large numbers
of indigent patients.

(c) A requirement that hospitals in such counties
provide a designated amount of uncompensated care for indigent patients would:

(1) Equalize the burden on such hospitals
of treating indigent patients; and

(2) Aid the counties in meeting their
obligation to compensate hospitals for such care.

(d) Hospitals with 100 or fewer beds have been
meeting the needs of their communities with regard to care of indigents, and
have a minimal effect on the provision of such care.

2. Except as otherwise provided in this
subsection, the provisions of NRS 439B.300 to 439B.340, inclusive, apply to each hospital in this
State which is located in a county in which there are two or more licensed
hospitals. The provisions of NRS 439B.300 to 439B.340, inclusive, do not apply to a hospital which
has 100 or fewer beds.

2. Who are ineligible for Medicare,
Medicaid, the Children’s Health Insurance Program, the benefits provided
pursuant to NRS 428.115 to 428.255, inclusive, or any other federal
or state program of public assistance covering the provision of health care;

3. Who meet the limitations imposed by the
county upon assets and other resources or potential resources; and

4. Whose income is less than:

(a) For one person living without another member
of a household, $438.

(b) For two persons, $588.

(c) For three or more persons, $588 plus $150 for
each person in the family in excess of two.

Ê For the
purposes of this subsection, “income” includes the entire income of a household
and the amount which the county projects a person or household is able to earn.
“Household” is limited to a person and the person’s spouse, parents, children,
brothers and sisters residing with him or her.

NRS 439B.320Hospital required to provide care for proportionate share of
indigent patients; duties of Department and board of county commissioners;
reimbursement for care.

1. A hospital shall provide, without
charge, in each fiscal year, care for indigent inpatients in an amount which
represents 0.6 percent of its net revenue for the hospital’s preceding fiscal
year.

2. The Department shall compute the
obligation of each hospital for care of indigent inpatients for each fiscal
year based upon the net revenue of the hospital in its preceding fiscal year
and shall provide this information to the board of county commissioners of the
county in which the hospital is located.

3. The board of county commissioners shall
maintain a record of discharge forms submitted by each hospital located within
the county, together with the amount accruing to the hospital. The amount
accruing to the hospital for the care, until the hospital has met its
obligation pursuant to this section, is the highest amount the county is paying
to any hospital in the county for that care. Except as otherwise provided in
subsection 2 of NRS 439B.330, no payment for
indigent care may be made to the hospital until the total amount so accruing to
the hospital exceeds the minimum obligation of the hospital for the fiscal
year, and a hospital may only receive payment from the county for indigent care
provided in excess of its obligation pursuant to this section. After a hospital
has met its obligation pursuant to this section, the county may reimburse the
hospital for care of indigent inpatients at any rate otherwise authorized by
law.

NRS 439B.330Eligibility of indigent for assistance; payment of hospital for
serving disproportionately large share of patients; discharge forms; appeal
from determination of county regarding indigent status.

1. Except as otherwise provided in this
subsection, subsection 2 and NRS 439B.300, each
county shall use the definition of “indigent” in NRS
439B.310 to determine a person’s eligibility for medical assistance
pursuant to chapter 428 of NRS, other than
assistance provided pursuant to NRS 428.115
to 428.255, inclusive.

2. A board of county commissioners may, if
it determines that a hospital within the county is serving a disproportionately
large share of low-income patients:

(a) Pay a higher rate to the hospital for
treatment of indigent inpatients;

(b) Pay the hospital for treatment of indigent
inpatients whom the hospital would otherwise be required to treat without
receiving compensation from the county; or

(c) Both pay at a higher rate and pay for
inpatients for whom the hospital would otherwise be uncompensated.

3. Each hospital which treats an indigent
inpatient shall submit to the board of county commissioners of the county of
residence of the patient a discharge form identifying the patient as a possible
indigent and containing the information required by the Department and the
county to be included in all such forms.

4. The county which receives a discharge
form from a hospital for an indigent inpatient shall verify the status of the
patient and the amount which the hospital is entitled to receive. A hospital
aggrieved by a determination of a county regarding the indigent status of an
inpatient may appeal the determination to the Director or a person designated
by the Director to hear such an appeal. The decision of the Director or the
designee of the Director must be mailed by registered or certified mail to the
county and the hospital. The decision of the Director or the designee of the
Director may be appealed to a court having general jurisdiction in the county
within 15 days after the date of the postmark on the envelope in which the
decision was mailed.

5. Except as otherwise provided in
subsection 2 of this section and subsection 3 of NRS
439B.320, if the county is the county of residence of the patient and the
patient is indigent, the county shall pay to the hospital the amount required,
within the limits of money which may lawfully be appropriated for this purpose
pursuant to NRS 428.050, 428.285 and 450.425.

6. For the purposes of this section, the
county of residence of the patient is the county of residence of that person
before he or she was admitted to the hospital.

1. Before September 30 of each year, each
county in which hospitals subject to the provisions of NRS
439B.300 to 439B.340, inclusive, are located
shall provide to the Department a report showing:

(a) The total number of inpatients treated by
each such hospital who are claimed by the hospital to be indigent;

(b) The number of such patients for whom no
reimbursement was provided by the county because of the limitation imposed by
subsection 3 of NRS 439B.320;

(c) The total amount paid to each such hospital
for treatment of such patients; and

(d) The amount the hospital would have received
for patients for whom no reimbursement was provided.

2. The Director shall verify the amount of
treatment provided to indigent inpatients by each hospital to which no
reimbursement was provided by:

(a) Determining the number of indigent inpatients
who received treatment. For a hospital that has contracted with the Department
pursuant to subsection 4 of NRS 428.030,
the Director shall determine the number based upon the evaluations of
eligibility made by the employee assigned to the hospital pursuant to the
contract. For all other hospitals, the Director shall determine the number
based upon the report submitted pursuant to subsection 1.

(b) Multiplying the number of indigent inpatients
who received each type of treatment by the highest amount paid by the county
for that treatment.

(c) Adding the products of the calculations made
pursuant to paragraphs (a) and (b) for all treatment provided.

Ê If the total
amount of treatment provided to indigent inpatients in the previous fiscal year
by the hospital was less than its minimum obligation for the year, the Director
shall assess the hospital for the amount of the difference between the minimum
obligation and the actual amount of treatment provided by the hospital to
indigent inpatients. If a decision of a county regarding the indigent status of
one or more inpatients is pending appeal before the Director or upon receiving
satisfactory proof from a hospital that the decision is pending appeal before a
court having general jurisdiction in the county pursuant to subsection 4 of NRS 439B.330, the Director shall defer assessing the
hospital the amount that may be offset by the determination on appeal until a
final determination of the matter is made.

3. If the Director determines that a
hospital has met its obligation to provide treatment to indigent inpatients,
the Director shall certify to the county in which the hospital is located that
the hospital has met its obligation. The county is not required to pay the
hospital for the costs of treating indigent inpatients until the certification
is received from the Director. The county shall pay the hospital for such
treatment within 30 days after receipt of the certification to the extent that
money was available for payment pursuant to NRS
428.050, 428.285 and 450.425 at the time the treatment was
provided.

4. The Director shall determine the amount
of the assessment which a hospital must pay pursuant to this section and shall
notify the hospital in writing of that amount on or before November 1 of each
year. The notice must include, but is not limited to, a written statement for
each claim which is denied indicating why the claim was denied. Payment is due
30 days after receipt of the notice, except for assessments deferred pursuant
to subsection 2 which, if required, must be paid within 30 days after the court
hearing the appeal renders its decision. If a hospital fails to pay the
assessment when it is due the hospital shall pay, in addition to the
assessment:

(a) Interest at a rate of 1 percent per month for
each month after the assessment is due in which it remains unpaid; and

(b) Any court costs and fees required by the
Director to obtain payment of the assessment and interest from the hospital.

5. Any money collected pursuant to this
section must be paid to the county in which the hospital paying the assessment
is located. The money received by a county from assessments made pursuant to
this section does not constitute revenue from taxes ad valorem for the purposes
of NRS 354.59811, 428.050, 428.285 and 450.425, and must be excluded in
determining the maximum rate of tax authorized by those sections.

1. The Department shall establish a
program to increase awareness of health care programs for children and to
encourage enrollment in such programs. The program must provide for the
dissemination of information to the public relating to health care services
that are available in this state to children who are under the age of 13 years,
including, without limitation, information concerning:

(a) Federal, state and local governmental
programs which provide health care services to such children;

(b) The requirements for eligibility to
participate in such programs; and

(c) The procedures for enrolling children in such
programs.

2. The information disseminated pursuant
to subsection 1 must encourage the use of the programs identified pursuant to
subsection 1 and must emphasize:

(a) The benefits of preventive health care
services to the well-being of children; and

(b) The reasons that preventive health care
services are more efficient in treating potential health care needs and are
more economical than obtaining emergency health care services which are often
required when symptoms of an illness are not promptly and properly treated.

3. The program must be designed to
disseminate information using the most effective means available to the extent
possible, including, without limitation, using:

(a) Words or graphics, or both, that promote
understanding of the information by the intended audience, considering the
average level of reading comprehension of and the language understood by the
audience.

(b) Printed materials that may be displayed at or
distributed to:

(1) Offices of the federal, state and
local government that have contact with parents of children who are under the
age of 13 years or direct contact with such children, or both, in the normal
course of business;

(2) Schools attended by children who are
under the age of 13 years;

(3) Public libraries;

(4) Providers of health care who provide
services to children who are under the age of 13 years;

(5) Child care facilities that provide
services to children who are under the age of 13 years;

(6) Organizations that provide
community-based services to parents of children who are under the age of 13
years, or to such children, or both; and

1. The Director shall evaluate the
effectiveness of the program established pursuant to NRS
439B.350 annually. The evaluation must include, without limitation,
measuring the effectiveness of the content, form and method of dissemination of
information through the program.

2. The Director shall make any necessary
recommendations to improve the program based upon the evaluation.

3. On or before December 31 of each year,
the Director shall provide a written report to the Interim Finance Committee
concerning the results of the evaluation and any recommendations made to
improve the program.

NRS 439B.370Director authorized to contract for certain services.The Director may, within the limits of
available money, contract for services to assist the Department in carrying out
the provisions of NRS 439B.350 and 439B.360.

NRS 439B.400Hospital must maintain and use uniform list of billed charges;
exception.Each hospital in this
State shall maintain and use a uniform list of billed charges for that hospital
for units of service or goods provided to all inpatients. A hospital may not
use a billed charge for an inpatient that is different than the billed charge
used for another inpatient for the same service or goods provided. This section
does not restrict the ability of a hospital or other person to negotiate a
discounted rate from the hospital’s billed charges or to contract for a
different rate or mechanism for payment of the hospital.

1. Except as otherwise provided in
subsection 4, each hospital in this State has an obligation to provide
emergency services and care, including care provided by physicians and nurses,
and to admit a patient where appropriate, regardless of the financial status of
the patient.

2. Except as otherwise provided in
subsection 4, it is unlawful for a hospital or a physician working in a
hospital emergency room to:

(a) Refuse to accept or treat a patient in need
of emergency services and care; or

(b) Except when medically necessary in the
judgment of the attending physician:

(1) Transfer a patient to another hospital
or health facility unless, as documented in the patient’s records:

(I) A determination has been made
that the patient is medically fit for transfer;

(II) Consent to the transfer has
been given by the receiving physician, hospital or health facility;

(III) The patient has been provided
with an explanation of the need for the transfer; and

(IV) Consent to the transfer has
been given by the patient or the patient’s legal representative; or

(2) Provide a patient with orders for
testing at another hospital or health facility when the hospital from which the
orders are issued is capable of providing that testing.

3. A physician, hospital or other health
facility which treats a patient as a result of a violation of subsection 2 by a
hospital or a physician working in the hospital is entitled to recover from
that hospital an amount equal to three times the charges for the treatment
provided that was billed by the physician, hospital or other health facility which
provided the treatment, plus reasonable attorney’s fees and costs.

4. This section does not prohibit the
transfer of a patient from one hospital to another:

(a) When the patient is covered by an insurance
policy or other contractual arrangement which provides for payment at the
receiving hospital;

(b) After the county responsible for payment for
the care of an indigent patient has exhausted the money which may be
appropriated for that purpose pursuant to NRS
428.050, 428.285 and 450.425; or

(c) When the hospital cannot provide the services
needed by the patient.

Ê No transfer
may be made pursuant to this subsection until the patient’s condition has been
stabilized to a degree that allows the transfer without an additional risk to
the patient.

5. As used in this section:

(a) “Emergency services and care” means medical
screening, examination and evaluation by a physician or, to the extent
permitted by a specific statute, by a person under the supervision of a
physician, to determine if an emergency medical condition or active labor
exists and, if it does, the care, treatment and surgery by a physician
necessary to relieve or eliminate the emergency medical condition or active
labor, within the capability of the hospital. As used in this paragraph:

(I) There is inadequate time before
delivery to transfer the patient safely to another hospital; or

(II) A transfer may pose a threat to
the health and safety of the patient or the unborn child.

(2) “Emergency medical condition” means
the presence of acute symptoms of sufficient severity, including severe pain,
such that the absence of immediate medical attention could reasonably be
expected to result in:

(I) Placing the health of the
patient in serious jeopardy;

(II) Serious impairment of bodily
functions; or

(III) Serious dysfunction of any
bodily organ or part.

(b) “Medically fit” means that the condition of
the patient has been sufficiently stabilized so that the patient may be safely
transported to another hospital, or is such that, in the determination of the
attending physician, the transfer of the patient constitutes an acceptable
risk. Such a determination must be based upon the condition of the patient, the
expected benefits, if any, to the patient resulting from the transfer and
whether the risks to the patient’s health are outweighed by the expected
benefits, and must be documented in the patient’s records before the transfer.

6. If an allegation of a violation of the
provisions of subsection 2 is made against a hospital licensed pursuant to the
provisions of chapter 449 of NRS, the
Division of Public and Behavioral Health of the Department shall conduct an
investigation of the alleged violation. Such a violation, in addition to any
criminal penalties that may be imposed, constitutes grounds for the denial,
suspension or revocation of such a license, or for the imposition of any
sanction prescribed by NRS 449.163.

7. If an allegation of a violation of the
provisions of subsection 2 is made against:

(a) A physician licensed to practice medicine
pursuant to the provisions of chapter 630 of
NRS, the Board of Medical Examiners shall conduct an investigation of the
alleged violation. Such a violation, in addition to any criminal penalties that
may be imposed, constitutes grounds for initiating disciplinary action or
denying licensure pursuant to the provisions of subsection 3 of NRS 630.3065.

(b) An osteopathic physician licensed to practice
osteopathic medicine pursuant to the provisions of chapter
633 of NRS, the State Board of Osteopathic Medicine shall conduct an
investigation of the alleged violation. Such a violation, in addition to any
criminal penalties that may be imposed, constitutes grounds for initiating
disciplinary action pursuant to the provisions of subsection 1 of NRS 633.131.

1. A hospital or related entity shall not
establish a rental agreement with a physician or entity that employs physicians
that requires any portion of his or her medical practice to be referred to the
hospital or related entity.

2. The rent required of a physician or
entity which employs physicians by a hospital or related entity must not be
less than 75 percent of the rent for comparable office space leased to another
physician or other lessee in the building, or in a comparable building owned by
the hospital or entity.

3. A hospital or related entity shall not
pay any portion of the rent of a physician or entity which employs physicians
within facilities not owned or operated by the hospital or related entity,
unless the resulting rent is no lower than the highest rent for which the
hospital or related entity rents comparable office space to other physicians.

4. A health facility shall not offer any
provider of medical care any financial inducement, excluding rental agreements
subject to the provisions of subsection 2 or 3, whether in the form of
immediate, delayed, direct or indirect payment to induce the referral of a
patient or group of patients to the health facility. This subsection does not
prohibit bona fide gifts under $100, or reasonable promotional food or
entertainment.

5. The provisions of subsections 1 to 4,
inclusive, do not apply to hospitals in a county whose population is less than
55,000.

6. A hospital, if acting as a billing
agent for a medical practitioner performing services in the hospital, shall not
add any charges to the practitioner’s bill for services other than a charge
related to the cost of processing the billing.

7. A hospital or related entity shall not
offer any financial inducement to an officer, employee or agent of an insurer,
a person acting as an insurer or self-insurer or a related entity. A person
shall not accept such offers. This subsection does not prohibit bona fide gifts
of under $100 in value, or reasonable promotional food or entertainment.

8. A hospital or related entity shall not
sell goods or services to a physician unless the costs for such goods and
services are at least equal to the cost for which the hospital or related
entity pays for the goods and services.

9. Except as otherwise provided in this
subsection, a practitioner or health facility shall not refer a patient to a
health facility or service in which the referring party has a financial
interest unless the referring party first discloses the interest to the
patient. This subsection does not apply to practitioners subject to the
provisions of NRS 439B.425.

10. The Director may, at reasonable
intervals, require a hospital or related entity or other party to an agreement
to submit copies of operative contracts subject to the provisions of this
section after notification by registered mail. The contracts must be submitted
within 30 days after receipt of the notice. Contracts submitted pursuant to
this subsection are confidential, except pursuant to the provisions of NRS 239.0115 and in cases in which an
action is brought pursuant to subsection 11.

11. A person who willfully violates any
provision of this section is liable to the State of Nevada for:

(a) A civil penalty in an amount of not more than
$5,000 per occurrence, or 100 percent of the value of the illegal transaction,
whichever is greater.

(b) Any reasonable expenses incurred by the State
in enforcing this section.

Ê Any money
recovered pursuant to this subsection as a civil penalty must be deposited in a
separate account in the State General Fund and used for projects intended to
benefit the residents of this State with regard to health care. Money in the
account may only be withdrawn by act of the Legislature.

12. As used in this section, “related
entity” means an affiliated person or subsidiary as those terms are defined in NRS 439B.430.

1. Except as otherwise provided in this
section, a practitioner shall not refer a patient, for a service or for goods
related to health care, to a health facility, medical laboratory, diagnostic
imaging or radiation oncology center or commercial establishment in which the
practitioner has a financial interest.

2. Subsection 1 does not apply if:

(a) The service or goods required by the patient
are not otherwise available within a 30-mile radius of the office of the
practitioner;

(b) The service or goods are provided pursuant to
a referral to a practitioner who is participating in the health care plan of a
health maintenance organization that has been issued a certificate of authority
pursuant to chapter 695C of NRS;

(c) The practitioner is a member of a group
practice and the referral is made to that group practice;

(d) The referral is made to a surgical center for
ambulatory patients, as defined in NRS
449.019, that is licensed pursuant to chapter
449 of NRS;

(e) The referral is made by:

(1) A urologist for lithotripsy services;
or

(2) A nephrologist for services and
supplies for a renal dialysis;

(f) The financial interest represents an
investment in a corporation that has shareholder equity of more than
$100,000,000, regardless of whether the securities of the corporation are
publicly traded; or

(g) The referral is made by a physician to a
surgical hospital in which the physician has an ownership interest and:

(1) The surgical hospital is:

(I) Located in a county whose population
is less than 100,000; and

(II) Licensed pursuant to chapter 449 of NRS as a surgical hospital and
not as a medical hospital, obstetrical hospital, combined-categories hospital,
general hospital or center for the treatment of trauma;

(2) The physician making the referral:

(I) Is authorized to perform medical
services and has staff privileges at the surgical hospital; and

(II) Has disclosed the physician’s
ownership interest in the surgical hospital to the patient before making the
referral;

(3) The ownership interest of the
physician making the referral pertains to the surgical hospital in its entirety
and is not limited to a department, subdivision or other portion of the hospital;

(4) Every physician who has an ownership
interest in the surgical hospital has agreed to treat patients receiving
benefits pursuant to Medicaid and Medicare;

(5) The terms of investment of each
physician who has an ownership interest in the surgical hospital are not
related to the volume or value of any referrals made by that physician;

(6) The payments received by each investor
in the surgical hospital as a return on his or her investment are directly
proportional to the relative amount of capital invested or shares owned by the
investor in the hospital;

(7) None of the investors in the surgical
hospital has received any financial assistance from the hospital or any other
investor in the hospital for the purpose of investing in the hospital; and

(8) Either:

(I) The governing body of every
other hospital that regularly provides surgical services to residents of the
county in which the surgical hospital is located has issued its written general
consent to the referral by such physicians of patients to that surgical
hospital; or

(II) The board of county
commissioners of the county in which the surgical hospital is located has
issued a written declaration of its reasonable belief that the referral by such
physicians of patients to that surgical hospital will not, during the 5-year
period immediately following the commencement of such referrals, have a
substantial adverse financial effect on any other hospital that regularly
provides surgical services to residents of that county.

3. A person who violates the provisions of
this section is guilty of a misdemeanor.

4. The provisions of this section do not
prohibit a practitioner from owning and using equipment in his or her office
solely to provide to his or her patients services or goods related to health
care.

5. As used in this section:

(a) “Group practice” means two or more
practitioners who organized as a business entity in accordance with the laws of
this state to provide services related to health care, if:

(1) Each member of the group practice
provides substantially all of the services related to health care that he or
she routinely provides, including, without limitation, medical care,
consultations, diagnoses and treatment, through the joint use of shared
offices, facilities, equipment and personnel located at any site of the group
practice;

(2) Substantially all of the services
related to health care that are provided by the members of the group practice
are provided through the group practice; and

(3) No member of the group practice
receives compensation based directly on the volume of any services or goods
related to health care which are referred to the group practice by that member.

(b) “Patient” means a person who consults with or
is examined or interviewed by a practitioner or health facility for purposes of
diagnosis or treatment.

(c) “Substantial adverse financial effect”
includes, without limitation, a projected decline in the revenue of a hospital
as a result of the loss of its surgical business, which is sufficient to cause
a deficit in any cash balances, fund balances or retained earnings of the
hospital.

(a) An “affiliated person” is a person controlled
by any combination of the hospital, the parent corporation, a subsidiary or the
principal stockholders or officers or directors of any of the foregoing.

(b) A “subsidiary” is a person of which either
the hospital and the parent corporation or the hospital or the parent
corporation holds practical control.

2. No hospital may engage in any
transaction or agreement with its parent corporation, or with any subsidiary or
affiliated person which will result or has resulted in:

(a) Substitution contrary to the interest of the
hospital and through any method of any asset of the hospital with an asset or
assets of inferior quality or lower fair market value;

(b) Deception as to the true operating results of
the hospital;

(c) Deception as to the true financial condition
of the hospital;

(d) Allocation to the hospital of a proportion of
the expense of combined facilities or operations which is unfavorable to the
hospital;

(e) Unfair or excessive charges against the
hospital for services, facilities or supplies;

(f) Unfair and inadequate charges by the hospital
for services, facilities or supplies furnished by the hospital to others; or

(g) Payment by the hospital for services,
facilities or supplies not reasonably needed by the hospital.

3. If the Director has reasonable cause to
believe that a violation of subsection 2 has occurred, the Director may conduct
an examination of any books and records of the hospital, parent corporation,
subsidiary or affiliated person which the Director deems pertinent to the
examination. The Director has the same authority to examine the parent
corporation, subsidiary or affiliated person and recover the cost of the
examination as the Director has with regard to the hospital. A parent
corporation, subsidiary or affiliated person which refuses to permit the
examination of its books and records is subject to the fine provided for in
subsection 4 for each day that access to the books or records is restricted.

4. If a hospital, parent corporation,
subsidiary or affiliated person is found, after notice and a hearing, to have
violated the provisions of this section, the Director may impose an
administrative fine of not more than $20,000 for each violation or the actual
amount of damage caused by the violation, whichever is greater.

5. Upon a second or subsequent violation
of the provisions of this section, the Director may commence a legal action in
the district court of any county to secure an injunction against further
violations of this section.

1. The Director may by regulation require
hospitals, other health facilities and providers of health services to submit
such information as is reasonably necessary for the Director to carry out the
provisions of this chapter.

2. Except as otherwise provided in
subsection 3, the Director shall by regulation require an examination of a
hospital by an independent auditor appointed by the Director to ensure
compliance with this chapter. The audits must be scheduled on a regular basis but
not more often than once each year. The hospital shall pay the costs of the
audit. A hospital may contract with the auditor to conduct other work for the
hospital in connection with the audit.

3. The Director shall not require an audit
of a hospital which has less than 100 beds or is subject to the provisions of chapter 450 of NRS. The Director shall by
regulation require such a hospital to submit audits of the hospital on a
regular basis but not more often than once each year.

4. If a hospital fails to comply with any
regulation adopted pursuant to this section or the Director has reason to
believe the hospital has violated any provision of this chapter, the Director
may conduct an examination or contract for an independent examination of the
hospital to determine whether it is in compliance with those provisions. The
hospital which is the subject of such an examination is responsible for payment
of the costs of the examination if the Director determines that the hospital
did violate a provision of this chapter.

5. Any person who fails to submit
information as required by any regulation adopted pursuant to this chapter to
the Department or fails to submit to an audit or examination pursuant to this
section is subject to an administrative fine of not more than $1,000 per
violation per day until the required information is submitted or the person
submits to the audit or examination.

NRS 439B.500Penalty for violation of chapter.In
addition to any civil or administrative penalty specifically provided in this
chapter, any person who violates a provision of this chapter shall be punished
by a fine of not more than $5,000 for each violation.

(Added to NRS by 1987, 873)—(Substituted
in revision for part of NRS 439B.450)